Objective To explore the value of various computed tomography (CT) features in the differential diagnosis of pulmonary thick-wall cancerous cavitation and inflammatory cavitation.

Methods Clinical imaging data were retrospectively analyzed for 71 patients with thick-wall cancerous cavitation and 98 patients with thick-wall inflammatory cavitation, confirmed through clinical or pathological diagnosis at our hospital. Differences in CT signs between the two groups were compared.

Results The maximum wall thickness, average wall thickness, and the ratio of the maximum-to-minimum thickness were significantly higher in thick-wall cancerous cavitations compared to those in thick-wall inflammatory cavitations. Among these, the maximum-to-minimum thickness ratio exhibited the best diagnostic performance for distinguishing thick-wall cancerous cavitations from inflammatory cavitations. In CT scans, thick-wall cancerous cavitations were more likely to appear lobulated and exhibit spiculated margins, pleural traction signs, vascular convergence signs, mural nodules, and mediastinal lymphadenopathy. In contrast, the CT scans of inflammatory cavitations frequently revealed patchy shadows around the cavity and smooth inner wall. Multivariate logistic analysis of the above parameters revealed lobulated appearance and pleural traction signs as risk factors for thick-wall cancerous cavitation, and patchy shadow around the cavity and smooth inner wall as risk factors for thick-wall inflammatory cavitation.

Conclusion Cavity wall thickness characteristics and accompanying CT findings are valuable in the differential diagnosis of pulmonary thick-wall cancerous cavitation and inflammatory cavitation.